Our Products
Home Policyholders

Medico® Insurance Company prides itself on personal service. So if you have a question about your policy, your claim, or need any other information please call:

Policyholder Questions: 1-800-228-6080

One of our dedicated, knowledgeable Client Services representatives will be happy to help you. Medico does not outsource its customer service, so when you call Medico your call will be handled in person, by someone at our Home Office in Omaha, NE.

We are standing by ready to help you find the answers you need.

Beyond calling Client Services, Policyholders can communicate with Medico Insurance Company to get answers and/or changes made to their insurance plan. Policyholders can: Click on the one of the form icons () shown below to get a copy of a form, print it, fill it out and mail or fax it to our Home Office.

Our mailing address is:

Medico Insurance Company
1515 S. 75th St.
Omaha, NE 68124

Our fax numbers are:

Client Services/Claims: 1-402-938-9459

For all other business: 1-402-391-6489
 

Change of Address Form
Have you moved? If so, follow the instructions below to change your address!

To submit a change of address:

  1. Open the change of address form by clicking here and printing it out.
  2. Fill out sections 1 through 5.
  3. Mail or fax the form to the address or fax number shown above.

This form can also be used to change phone numbers.

Automatic Withdrawal Form
Signing up to have your premium payment automatically withdrawn from your bank account is an easy and convenient way of ensuring that your policy remains in force.

Enrollment is easy. Follow these instructions:

  1. Open the authorization form by clicking here and printing it out.
  2. Fill out sections 1 through 4.
  3. Write "VOID" across a blank unsigned check and attach to the form.
  4. Mail or fax the form to the address or fax number shown above.

The authorization form can also be used to change bank accounts.

Claim Forms
Please follow the steps below to file a claim.

To file a claim:

  1. Click on the appropriate claim form below and print it out.
  2. Fill out the form as instructed.
  3. Mail or fax the form to the address or fax number shown above.

Cancer and Disability Claim Form
Use this form if you have a cancer policy or a disability policy with Medico Insurance Company or Medico Life Insurance Company.

Hospital Confinement Claim Form
Use this form if you have a hospital indemnity plan with Medico Insurance Company or Medico Life Insurance Company.

Life Claim Form
Use this form if you have a life insurance policy with Medico Life Insurance Company.

Dental Claim Form
Use this form if you have a dental policy with Medico Insurance Company. Staff from the dentist's office can complete and submit this form with the billing.

Vision Claim Form
Use this form if you have a vision policy with Medico Insurance Company. Staff from the provider's office can complete and submit this form with the billing.

Hearing Claim Form
Use this form if you have a hearing policy with Medico Insurance Company. Staff from the doctor's office can complete and submit this form with the billing.

Short-Term Care Forms

Short-Term Care Claim Form
Use this form if you have a short-term care insurance policy form NHA06, NHA07, or NHA30 issued through Medico Insurance Company or Medico Life Insurance Company and you are making a claim for nursing facility care, assisted living care or home health care. This form is for policies purchased in 2006 or later.

Short-Term Care Attending Physician's Statement
This form is used for short-term care policy forms NHA06, NHA07, or NHA30 purchased in 2006 or later. It is a form that must be completed and submitted by the attending physician.

Short-Term Care Facility Certification of Care
This is a form for those NHA06, NHA07, or NHA30 policyholders who are moving from one facility to another or who are going into a facility for the first time. Staff from the facility need to complete and submit this form.

Short-Term Care Monthly Verification of Continuing Care
This is a form to be completed by facility staff. This form is used to verify continuing care for NHA06, NHA07, or NHA30 policyholders. It must be submitted each month with the billing.

Long-Term Care Forms

Long-Term Care Claim Form
Use this form if you have a long-term care insurance policy with BlueCross BlueShield of Florida and you are making a claim for nursing facility care, assisted living care, home health care or alternative care.

Long-Term Care Attending Physician's Statement
This form is used by those policyholders who have a long-term care insurance policy with BlueCross BlueShield of Florida. It is a form that must be completed and submitted by the attending physician.

Long-Term Care Certification of Care
This is a form for those policyholders who have a long-term care insurance policy with BlueCross BlueShield of Florida and are moving from one facility to another or who are going into a facility for the first time. Staff from the facility need to complete and submit this form.

Long-Term Care Monthly Verification of Continuing Care
This is a form to be completed by facility staff. This form is used to verify continuing care for policyholders who have a long-term care insurance policy with BlueCross BlueShield of Florida. It must be submitted each month with the billing.

Medicare Select Hospital Network Listing
Medico Insurance Company is providing your hospital NETWORK through USA Senior Care Network. Click Here to access the USA SENIOR CARE NETWORK listing of hospitals.

Adobe Acrobat Reader Required: To open forms on this page you must have Adobe Acrobat Reader installed. If you do not have Adobe Acrobat Reader installed on your computer click here to download a free version from the Adobe website.

We're Here to Help You
1-800-228-6080

Our knowledgeable Client Services representatives are standing by, ready to help you find what you need.

Our office hours are:

Monday-Thursday
7:30 am-4:45 pm (CT)
Friday
7:30 am-11:30 am (CT)
Terms and Conditions | Privacy Policy | HIPAA Privacy Notices & Forms
© 2009 Medico® Insurance Company
WW-0004 01152009
 Medico® Insurance Company - Protecting Your Future Today®